Morton’s neuroma is a thickening of tissue around a nerve in the ball of your foot, most often between the third and fourth toes. It’s not a true tumor despite the name. Instead, repeated pressure or irritation causes the nerve to swell and develop scar-like tissue around it, producing sharp or burning pain that can feel like you’re standing on a pebble. The condition is common, affecting roughly 30 to 33% of the general population to some degree, and it strikes women about four times more often than men.
What’s Actually Happening in Your Foot
Between each pair of metatarsal bones (the long bones behind your toes), a small nerve runs along the underside of your foot. In Morton’s neuroma, one of these nerves gets repeatedly compressed or irritated. Over time, the tissue surrounding the nerve thickens and the nerve itself swells. This usually happens in the space between the third and fourth metatarsal heads, though the space between the second and third is the next most common site.
The result isn’t cancerous growth. It’s more like a callus forming around the nerve itself, a buildup of fibrous tissue that presses on the nerve and amplifies pain signals. The more irritated it gets, the thicker the tissue becomes, and the worse the symptoms feel.
What It Feels Like
The hallmark sensation is a sharp, burning pain in the ball of your foot that often radiates into two adjacent toes. Many people describe it as feeling like there’s a marble or folded sock bunched up under the front of their foot. Tingling or numbness in the affected toes is also common.
Symptoms tend to come and go at first. You might notice pain flare up during a long walk or run and then fade once you sit down and take off your shoes. Over time, without changes to footwear or activity, the discomfort can become more persistent. Pain typically worsens with walking, standing for long periods, or any activity that loads the forefoot.
Causes and Risk Factors
Anything that squeezes or repeatedly stresses the front of the foot can set the stage for Morton’s neuroma. The most common culprits are:
- High heels and narrow shoes. Pointed toe boxes and elevated heels shift your body weight forward onto the ball of your foot, increasing pressure on the nerve. This is a major reason the condition is so much more prevalent in women.
- Foot deformities. Bunions, hammertoes, high arches, and flat feet all change how weight distributes across the forefoot. Bunions in particular crowd the smaller toes together and create extra compression between the metatarsal heads.
- High-impact activities. Running, court sports, and other activities that involve repetitive push-off from the forefoot can irritate the nerve over time.
The average age at diagnosis hovers around the mid-40s, though it can develop in adults of any age.
How It’s Diagnosed
A doctor can often identify Morton’s neuroma through a physical exam. One common test involves squeezing the foot from side to side while pressing on the space between the metatarsal heads. In some cases this produces an audible or palpable click, known as Mulder’s click, which suggests the thickened nerve is being displaced. That test has about 61% sensitivity, so a negative result doesn’t rule it out.
When the exam is inconclusive, ultrasound is typically the first imaging step. It picks up neuromas with about 96% sensitivity and can detect growths smaller than 5 mm. MRI is another option, but it tends to miss very small neuromas (those under 5 mm) more often than ultrasound does. In one study, three patients with negative MRI findings were later found to have sub-5 mm neuromas on ultrasound. For this reason, ultrasound is often preferred as the initial scan.
Conservative Treatment
Most people start with non-surgical approaches, and many find enough relief that they never need an injection or operation.
The simplest change is footwear. Switching to shoes with a wide toe box and low heel immediately reduces compression on the nerve. This alone can make a significant difference, especially if tight or high-heeled shoes were the primary trigger.
Metatarsal pads are another effective tool. These small, dome-shaped cushions sit inside your shoe just behind the ball of your foot, not directly under the painful spot. Placed correctly, they spread the metatarsal heads apart and relieve pressure on the nerve between them. For Morton’s neuroma specifically, a smaller pad positioned just behind the two metatarsal heads that are pinching the nerve works best. Getting the placement right matters: too far forward and the pad presses on the sore area instead of lifting it.
Custom orthotics can serve a similar function, especially if an underlying foot deformity like flat feet or high arches is contributing to the problem. Reducing high-impact activities or switching temporarily to lower-impact exercise (cycling, swimming) also helps by giving the nerve time to calm down.
Injections
When conservative measures aren’t enough, injections are the next step. Two types are commonly used.
Corticosteroid injections reduce inflammation around the nerve and can provide quick pain relief. About half of patients get a temporary response, and roughly 30% achieve lasting relief from a single shot. If pain returns, a second injection can be tried, though the odds of a durable response drop with repeat treatments. These are typically limited to two or three rounds because steroids can weaken surrounding tissue over time.
Alcohol sclerosing injections take a different approach. A diluted alcohol solution is injected around the nerve over a series of four sessions, gradually deadening the nerve tissue. This method has a higher overall success rate of about 70%. It requires more visits, but for people who don’t respond to steroids, it offers a meaningful alternative before considering surgery.
Surgery and Recovery
If injections and conservative care don’t control the pain, surgical removal of the affected nerve (neurectomy) is the standard procedure. Long-term studies show that 76.5% of patients report good or excellent outcomes after surgery. Success rates in the literature range from about 51% to 85% depending on the study and follow-up period.
The tradeoff is numbness. Because the nerve is physically removed, about 72% of patients have reduced sensation or numbness in the skin between the affected toes afterward. Most people find this tolerable compared to the pain they were living with. Only about 1% report bothersome abnormal sensations at the surgery site.
The most notable complication is a stump neuroma, where the cut end of the nerve develops its own painful thickening. This occurred in about 8% of feet in one large study and was responsible for all of the poor outcomes in that group.
Recovery is relatively quick. You can walk on your heel immediately after surgery. Most people transition into a soft trainer-style shoe within two to four weeks, with many finding they can do so comfortably by the 10 to 14 day mark. Full return to normal activity typically follows within a few weeks after that, depending on comfort.
What Helps Most in the Long Run
Whether you manage Morton’s neuroma conservatively or go through surgery, footwear remains the single most important long-term factor. Shoes with a roomy toe box, adequate cushioning, and a low heel protect the forefoot from the compression that caused the problem in the first place. If you run or play sports, choosing shoes designed for your foot type and replacing them before they lose cushioning can prevent recurrence. Keeping a metatarsal pad in your everyday shoes is a low-cost habit that maintains the spacing between metatarsal heads and keeps pressure off the nerve.